MEDICARE: LABORATORIO VASCULAR CLINICO PONCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1598735565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO VASCULAR CLINICO PONCE INC

Provider Business Mailing Address
First Line	:	PO BOX 7123
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-7123
Country	:	US
Telephone Number	:	787-840-0670
Fax Number	:	787-841-6442

Provider Business Practice Location Address
First Line	:	2213 PONCE BY PASS
Second Line	:	HOSPITAL DAMAS PRIMER PISO
City	:	PONCE
State	:	PR
Zip	:	00717-1318
Country	:	US
Telephone Number	:	787-840-0670
Fax Number	:	787-841-6442

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. WILLIAM BRACER
Credential	:	MD
Telephone Number	:	787-840-0670

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	04/05/2024

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Practice Location Address:

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Practice Location Address:

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